Pelvic Health

How the pelvic floor works, what can go wrong, and how physiotherapy assesses and treats it.

Pelvic health refers to how well the muscles, organs, nerves, and connective tissues in and around your pelvis work together. These structures influence bladder and bowel control, sexual function, pelvic organ support, pregnancy and postpartum recovery, movement, comfort, and overall quality of life.

What is pelvic health?

At the base of the pelvis is a group of muscles called the pelvic floor. These muscles form a supportive hammock between the pubic bone and the tailbone. They help:

Support the bladder, bowel, and reproductive organs
Control urine, stool, and gas
Relax for urination and bowel movements
Contribute to sexual comfort and function
Manage pressure during coughing, lifting, running, and exercise
Work with the diaphragm, abdominal muscles, hips, and back to support movement

Pelvic health is more than having “strong” pelvic floor muscles. The muscles must be able to contract, relax, coordinate, and respond at the right time.

What is pelvic floor dysfunction?

Pelvic floor dysfunction occurs when the pelvic floor muscles or surrounding structures are not working as effectively or comfortably as they should. The muscles may be:

Weak or lacking endurance
Overactive, tense, or painful
Difficult to relax
Poorly coordinated with breathing and movement
Affected by injury, surgery, pregnancy, childbirth, hormonal changes, or other health conditions

This is why Kegel exercises are not appropriate for everyone. Someone with an overactive or painful pelvic floor may need relaxation, coordination, and breathing strategies — not simply more strengthening.

How the muscles may behave

Weak

Low strength or endurance — not enough support and control.

Overactive

Held constantly tense — the muscles struggle to fully relax.

Coordinated

Contracts and relaxes on cue, with the right timing.

Signs you may benefit from pelvic health physiotherapy

Consider speaking with a pelvic health physiotherapist if you experience any of the following. These symptoms are common, but they should not automatically be accepted as a normal part of pregnancy, aging, sport, or parenthood.

Bladder symptoms

Urine leakage with coughing, sneezing, laughing, lifting, or exercise
A sudden or difficult-to-control urge to urinate
Frequent urination, or waking repeatedly at night
Difficulty starting or fully emptying your bladder

Bowel symptoms

Constipation or frequent straining
Difficulty emptying your bowels
Accidental loss of stool or gas
Pain with bowel movements

Pelvic pain & sexual health

Pelvic, vaginal, vulvar, penile, testicular, rectal, or tailbone pain
Pain with penetration, intercourse, or pelvic examinations
Pain associated with endometriosis or other pelvic conditions
Persistent tension or pressure in the pelvic area
Concerns affecting sexual comfort or function

Pelvic organ support

Vaginal heaviness, pressure, or bulging
Symptoms associated with pelvic organ prolapse
Difficulty exercising or lifting because of pelvic pressure

Pregnancy & postpartum

Pelvic girdle, pubic bone, hip, or lower-back pain during pregnancy
Preparation for birth and postpartum recovery
Perineal tearing, episiotomy, or caesarean birth recovery
Abdominal wall changes, including diastasis recti
Returning safely to running, lifting, sport, or sexual activity

Perimenopause & menopause

Bladder, pelvic pain, or prolapse symptoms during perimenopause and menopause
Changes in tissue comfort and pelvic support as hormones shift

Risk factors for pelvic floor dysfunction

Pelvic floor dysfunction can affect people of any gender or age. It develops when the pelvic floor muscles and supporting tissues become weakened, overactive, injured, or poorly coordinated. Usually several factors contribute over time rather than one single cause. Common risk factors include:

Pregnancy and childbirth, particularly vaginal birth, assisted delivery, prolonged pushing, or significant perineal injury
Increasing age and hormonal changes during perimenopause and menopause
Chronic constipation or regularly straining during bowel movements
Persistent coughing caused by smoking, asthma, or respiratory conditions
Higher body weight, which can increase pressure on the pelvic floor
Pelvic or abdominal surgery, including hysterectomy and prolapse surgery
Pelvic injury, radiation therapy, or scar tissue
Repeated heavy lifting or high-impact activity without adequate pressure management
Connective-tissue conditions, joint hypermobility, or a family history of pelvic floor disorders
Neurological conditions affecting pelvic sensation, strength, or coordination
Diabetes and other conditions that may affect muscles, nerves, or bladder function
A history of pelvic pain, painful intercourse, or habitual pelvic muscle guarding

Having one or more risk factors does not mean that pelvic floor dysfunction is inevitable, and symptoms can also develop without an obvious risk factor. A pelvic health physiotherapist can assess whether the muscles are weak, tense, painful, or poorly coordinated, and develop an individualized treatment plan. Seek an assessment if you experience urine or stool leakage, constipation, pelvic pressure or heaviness, pelvic pain, painful sex, difficulty emptying your bladder or bowels, or changes following childbirth or pelvic surgery.

Evidence sources
NICE NG210 — Pelvic floor dysfunction: prevention and non-surgical management; NICHD (US National Institutes of Health) — Pelvic Floor Disorders.

What is pelvic health physiotherapy?

Pelvic health physiotherapy is a specialized area of physiotherapy focused on bladder, bowel, sexual, and pelvic floor function. It also considers how the pelvis works with your breathing, abdominal wall, spine, hips, and daily activities.

At SOMOM Pelvic Health & Family Wellness, in Toronto’s High Park, care begins with a private conversation about your symptoms, medical history, goals, and concerns. Your physiotherapist may assess:

Breathing and pressure management
Posture, movement, and lifting strategies
Abdominal, hip, back, and pelvic muscle function
Pelvic floor strength, endurance, relaxation, and coordination
Scar mobility and tissue sensitivity
Bladder, bowel, and exercise habits

An internal vaginal or rectal examination may be offered when clinically relevant, but it is never automatic or required. It is performed only with your informed consent, and you may decline or stop the examination at any time.

How can pelvic health physiotherapy help?

Your treatment plan will depend on what is contributing to your symptoms. It may include:

Individualized pelvic floor muscle training
Pelvic floor relaxation and coordination
Breathing and pressure-management strategies
Bladder retraining and urgency-management techniques
Bowel-emptying positions and constipation education
Manual therapy when appropriate
Scar and soft-tissue rehabilitation
Hip, abdominal, back, and whole-body exercise
Pregnancy and birth preparation
Postpartum rehabilitation
Guidance for returning to lifting, running, work, intimacy, or sport

Clinical guidelines support supervised pelvic floor muscle training as a first-line, non-surgical treatment for several forms of urinary incontinence, and as a management option for some prolapse symptoms. Treatment should be based on an individual assessment rather than a universal exercise program.

Evidence source
NICE NG210 — Pelvic floor dysfunction: prevention and non-surgical management.

Considering an assessment?

A pelvic health physiotherapy assessment identifies what is contributing to your symptoms and establishes an individualized plan.

Book an assessment